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Home My WebLink About1856 PENTAS CT; ; CBR2022-3933; Permit                                                    (Cityof Carlsbad ( City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check Est. Value PC Deposit Date Job Address ( &Sb ~t~'\ ~l;:) \. ~ 1 '--t\V-.b~ J C., t\ Unit: _____ APN: __________ _ CT/Project #: __________________ Lot #: ____ Year Built: _________ _ BRIEF DESCRIPTION OF WORK: --------------------------·----- □ New SF : Living SF, ____ Dec k SF, ___ Patio SF, ____ Garage SF __ _ Is t his to create an Accessory Dwelling Unit? O Y o N New Fireplace? O YO N, if yes how many? ___ _ D Remodel: SF of affected area Is the area a conversion or change of use? 0 Y 0> N ----- □ Pool/Spa: _____ SF Additional Gas or Electrical Features? ____________ _ □Solar: KW, odules, Mounted:Q Roof O Ground, ---____ , Tilt: 0 Y0 N, RMA: Q)Y O N, Y O>N Electric Meter number: ------------Battery:O YO> N, Panel Upgrade: Other: ~ • APPLICANT (PRIMARY CONTACT) PROPERTY OWNER Name: ~~ Th\lV'~ Name: C-iN~\\\ C,y~\v Address:~ \-\Orb:::::-2c, f:t\J;<.. Address: ~S\;i S)eNTu½ (,~ City: S,,.A D::-G:) A State: <..fl-Zip: :?i \~~\ City: C.,f:'U,,Sf?fW) State: Cfr Zip: '\"\,() l\ . --- Phone: \0 l'\ I:.\~ SL),_.'C) Phone: --------------------Em a i I:. __________________ Em a i I: ___________________ _ DESIGN PROFESSIONAL CONTRACTOR OF RECORD Name: ______________ BusinessName: \'!\,'"S" X:.l'.f~~\l 'Nl, Address: Address: :3:\s. 5 \½5:'C:xe:, (!~ City: _______ State: ___ Zip:____ City: L Pr-i':"'Ybt>t State: Cf+. Zip: ~ l i 41 Phone: Phone: (g l Cl\ C\ io ':> C. 1..-0 Email: Email: _____________ """T"" ____ _ Architect State License: CSLB License#: 9, S \ !\f\,,l, Carlsbad Business License# (Required): _______ _ APPLICANT CERT/FICA TION: I certify that I have read the application and state that the above information is correct and that the information of the plans is accurate. I 0::::m;:;::~,:•• 0;;;~~"';:~t ,,,Jdmg ~•:'"':. -/DATE: /!) f / ~ ( 17- 1635 fa,ada, A-e Ca,isbad, CA 92008 eh "2-339-27w =& Ema" Mdmg@cadsbad,a.p REV 04/22 THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: ______ _ A BUILDING PERMIT CAN BE ISSUED TO EITHER A STATE LICENSED CONTRACTOR OR A PROPERTY OWNER. IF THE PERSON SIGNING THIS FORM IS AN AGENT FOR EITHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. (OPTION A); LICENSED CONTRACTOR DECLARATION: I herebyaff irmunder penalty of perjury that I am licensed under provisions of Chapter 9 ( commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. I also affirm under penalty of per1uryoneof the fgll~g dec{arations(CHOOSE ONE): 1'¢ and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the ·h1ch this permit Is issued. PolicyNo. ___________________________________________ _ A)R- 1 have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the perfor~ ork for which this permit is issued. 'My workers' compensation Insuranc car~er and f ~licy n mber are: Insurance Company Name: ---'--'ft''-'--_.._'"'-'-1__. _ ___,__-c"c.,...,.-,,'="~~---------- Policy No. --A-f1"::>1. ExpirationDate: ___ __,-'-'L-=_!),L_ _______ _ -OR- D Certificate of Exemption: I certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation Laws of California. WARNING: Failure to secure workers compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000.00, in addition the to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there Is a construction lending agency for t he performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name: ________________________ Lender's Address: _____________________ _ CONTRACTOR CERT/FICA TION: The applicant certifies that all documents and plans clearly and accurately show all existing and proposed buildings. structures, access roads, and utilities/utility easements All proposed modifications and/or additions are clearly labeled on the site plan. Any potentially existing detail w1th1n these plans incons stert with the site plan a·e not approved for constructIor and may be requ•red to be altered or removed The c ty's approva of the applicat'on Is based on the premise that the submitted documents and p,ans show the correct dimensions of; the property, buildings, structures and their setbacks from property 11nes and from one another; access roads/easements, and utilities. The existing and proposed use of each building as stated is true and correct; all easements and other encumbrances to developnent have been accurately shown and labeled as well as all on-site grading/site preparation. All improvements ex1st1ng on the property were completed in accordance with all regula:ions in existence at the time of their construction, unless otherwise noted. NAME (PRINT): ~~ Jfaj /V\t:-SIGNATURE:~ DATE: pf l\ h,, 1,, Note: If the person signing above is an authorized agent for the contractor provide (OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: D I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). -OR- DI, as cwner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). -OR- DI am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: A:\D. D FORM 8-61 "Owner Builder Acknowledgement and Verification Form" Is required for any permit issued to a property owner By my signature below I acknowledge that, except for my personal residence I~ wh1Cn I must have resided for at east one year p,Ior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner-builder if It has not been constructed in ,ts entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions lode, 1s available upon request when this application is submit ted or at the following Web site: http:/ /www.leginfo.ca.gov/calaw.html. OWNER CERT/FICA TION: The appl1Cant certifies that all documents and plans clearly and accurate y show all existing and proposed buildings, structures, access roads, and ut1l1t1es/utility easements. All proposed mod1hcat1ons and/or add1t1ons are clearly labeled on the site plan Any potentially existing detail within these plans inconsistent with the site plan are not approved for construction and may be required to be altered or removed The city's approval of the app'1cation Is based on the premise that t~e submitted documents and plans show the correct d1mens1ons cf; the property, buildings, structures and their setbacks from property lines and from one another; access roads/easements, and utilities The ex1sting and proposed use o' each building as stated Is true and correct; all easements and other encumbrances to developMent have been accurately shown and labeled as well as all on-site grading/site preparation. All improvements existing on the property were completed in accordance with all regulations in existence at the time of their construction, unless otherwise noted NAME (PRINT): SIGN : _________ DATE: _____ _ Note: If the person signing abov_e is an authorized agent for the property owner include form 8-62 signed by property ow ner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Bullding@carlsbadca.gov 2 REV. 04/22                                   {city of Carlsbad